Implementating a Chest Pain Screening Tool in a Primary Care Setting

Abstract

NURS 8269 DNP Scholarly Project Abstract: Background and Significance: Chest pain is one of most common complaints that prompt patients to seek medical assistance in the primary care setting and is typically ruled out as non-cardiac once a thorough assessment is completed (Bostock-Cox, 2012). Providers need to distinguish between typical vs. atypical presentation of cardiac pain to prevent a misdiagnosis. Each year inaccurate assessments of chest pain results in an increase in health care costs to emergency departments due to the increased number of visits or needless referrals (Ebell, 2011). Problem Statement: Patients often have difficulty describing their pain to the health care provider and assume that all pain in the epigastric or abdominal area is cardiac pain (McConaghy & Oza, 2013). The purpose of this project was to implement a Cardiac Screening Tool in the outpatient setting to aid patients in the proper identification and description of the pain components of unstable angina. The goal was to facilitate the identification of patients with typical angina vs. atypical angina. Methodology: A primary care practice in eastern North Carolina was approached for implementation of a quality improvement project. Training was provided to provider and staff on the screening tool. Patients were provided with a three-part modified version of the Marburg Chest Pain Screening Tool (Cayley, 2014). The first part of the tool identified gender and age specifications, part II addressed questions related to acute coronary signs and symptoms. Part III addressed signs and symptoms of anxiety (Cayley, 2014). To ensure adequate readability of the revised tool, a document test readability assessment was performed. Based on the Flesch-Kincaid readability score, the modified Marburg Chest Pain Assessment Tool was found to be on a 5th grade reading level, which was appropriate for the population in eastern North Carolina (Adamovic, 2009). The screening tool was offered to all patients age 30 years and older. The Input Output Process (IPO) quality improvement (QI) model served as the approach for this project (HRSA, 2011). Evaluation Method: After the implementation phase was completed, an analysis was performed to evaluate the data by ICD-10 codes, the year of collection, number of EKG’s performed, and number of referrals. Findings: More patients were identified with anxiety disorders than typical cardiac pain. A comparison of the previous practice pattern of ordering electrocardiograms in the practice during the implementation period found that fewer patients were evaluated with electrocardiograms (EKG’s) or referred for advanced cardiac assessments. Conclusion: The chest pain screening tool aided healthcare providers in determining typical or atypical cardiac chest pain. Keywords: Unstable angina, stable angina, atypical angina, chest pain, Input, Process, Output